Basic Information
Provider Information
NPI: 1417929282
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUDEK
FirstName: JOSEPH
MiddleName: JAMES
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 400 PATROON CREEK BLVD
Address2: SUITE 1
City: ALBANY
State: NY
PostalCode: 122065004
CountryCode: US
TelephoneNumber: 5184489004
FaxNumber:  
Practice Location
Address1: 400 PATROON CREEK BLVD
Address2: SUITE 1
City: ALBANY
State: NY
PostalCode: 122065004
CountryCode: US
TelephoneNumber: 5184890044
FaxNumber: 5184893591
Other Information
ProviderEnumerationDate: 02/06/2006
LastUpdateDate: 03/19/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X182271NYY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


Home